Objectives: Two objectives were set for this study. The first was to identify factors
influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The
second was to devise a predictive model for prolonged LOS in the Cardiac Intensive Care
Unit (CICU) based on preoperative factors available at admission and to compare it against
two existing cardiac stratification systems.
Design: Observational retrospective study.
Settings: A tertiary hospital in Oman.
Participants: All adult patients who underwent cardiac surgery at a major referral hospital in
Oman between 2009 and 2013.
Results: 30.5% of the patients had prolonged LOS (≥ 11 days) after surgery. While 17%
experienced prolonged ICU LOS (≥ 5 days). Factors that were identified to prolong CICU
LOS were non-elective surgery, current congestive heart failure (CHF), renal failure,
combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated
valve or CABG surgery. Patients were divided into three groups based on their scores. The
probabilities of prolonged CICU LOS were 11%, 26%, and 28% for group 1, 2, and 3
respectively. The predictive model had an area under the curve of 0.75. Factors associated
with prolonged overall postoperative LOS included the body mass index, the type of surgery,
cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and
number of complications. The latter was the most important determinant of postoperative
LOS.
Conclusion: Patient management can be tailored for individual patient based on their
treatments and personal attributes to optimise resource allocation. Moreover, a simple
predictive score system to enable identification of patients at risk of prolonged CICU stay
can be developed using data that are routinely collected by most hospitals.